Path 6 Biliary Tract

Question 1

CCK role

Answer 1

Gallbladder contraction

Question 2

Cholelithiasis

Answer 2

Gall stones

-Cholesterol, Bilirubin, Calcium salts

Question 3

Cholelithiasis risk factors (4)

Answer 3

• Chronic hemolysis (increased bilirubin)
• Crohns (bile salt malabsorption)
• Biliary tract infection
• Cirrhosis

Question 4

3 stone locations

Answer 4

Cholelithiasis (cystic)
Hepatolithiasis (hepatic)
Choledocholithiasis (common)

Question 5

Biliary Colic

Answer 5

• Gall obstruction
• Spasmodic RUQ pain
• Tx with cholecystectomy

Question 6

Cholesterolosis

Answer 6

• Strawberry gallbladder

- Lipid-containing macrophages in lamina propria

Question 7

Polypoid cholesterolosis

Answer 7

Foamy macrophages forming polypoid excresences

Question 8

Acute cholecystitis clinical

Answer 8

• RUQ rigidity, pain to right shoulder
• Increased WBC
• Increased serum Alkaline Phosphatase

Question 9

Chronic cholecystitis clinical

Answer 9

• Fatty food intolerance
• Nausea, vague RUQ pain
• Cancer risk

Question 10

Differentiate acute from chronic

Answer 10

• Always enlarged
• Fibrinous serosa
• Neutrophils v. eosinophils
• Turbid v. normal bile

Question 11

Chronic cholecystitis histology

Answer 11

• Rokitansky-Aschoff sinuses

- Mucosal outpouchings

Question 12

Porcelain gallbladder

Answer 12

• Chronic inflammation -> calcium

- Carcinoma risk

Question 13

Gene for choledocholithiasis

Answer 13

-MDR3 gene (impaired biliary phospholipid secretion)

Question 14

Charcot’s triad

Answer 14

Cholangitis

• Intermittent abdominal pain
• Spiking fever with chills
• Jaundice

Question 15

Perinatal biliary atresia

Answer 15

• Normal biliary tree destroyed at birth

- Jaundice in 2 weeks

Question 16

Fetal biliary atresia

Answer 16

• Immediate jaundice

- Associated with other congenital malformations

Question 17

Biliary atresia histology

Answer 17

• Bile duct proliferation
• Portal fibrosis
• Bile plugs in ducts

Question 18

Biliary atresia type I, II, III

Answer 18

I - common bile duct
II - hepatic bile duct
III - all ducts (above porta hepatis)

Question 19

Biliary atresia presentation

Answer 19

Normal at first, problems (cirrhosis) in a few weeks

Question 20

Biliary atresia Tx

Answer 20

• Kasai procedure for type I, II

- Liver transplantation for rest

Question 21

Choledochal cyst

Answer 21

Congenital dilatation of bile duct

Question 22

Gallbladder carcinoma risk, type

Answer 22

• Cholelithiasis

- Usually adenomacarcinoma

Question 23

Cholangiocarcinoma

Answer 23

Carcinoma lining bile ducts